Master Ophthalmology
for DHA
Access 30+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Ophthalmology covers the anatomy, physiology, and diseases of the eye. Key structures: cornea (refraction), lens (accommodation, cataracts), retina (photoreceptors, diabetic retinopathy (DR), AMD), optic nerve (vision transmission, glaucoma). Essential concepts: visual acuity (Snellen chart), intraocular pressure (IOP). High-yield conditions: cataracts (painless, progressive blur), glaucoma (optic neuropathy, visual field loss), DR (retinal microvascular damage), age-related macular degeneration (AMD - central vision loss), and common refractive errors.
Clinical Presentation
- Vision Loss: Sudden (CRAO, Retinal Detachment (RD), Optic Neuritis (ON)) vs. Gradual (Cataract, Glaucoma, AMD). Painful (Acute Angle-Closure Glaucoma, ON, Keratitis, Uveitis) vs. Painless (CRAO, AMD, DR). Central (AMD, Macular Edema) vs. Peripheral (Glaucoma). Transient (Amaurosis Fugax).
- Red Eye: Conjunctival injection (conjunctivitis) vs. Ciliary flush (keratitis, uveitis, acute glaucoma). Associated discharge, itching, photophobia.
- Eye Pain: Sharp (corneal abrasion) or deep/aching (scleritis, orbital cellulitis, acute glaucoma).
- Diplopia (Double Vision): Monocular (refractive error, cataract) vs. Binocular (cranial nerve (CN) palsies, orbital disease).
- Floaters & Flashes: Sudden onset suggests vitreous detachment or retinal tear/RD.
- Photophobia: Common in corneal abrasions, keratitis, uveitis, acute glaucoma.
- Systemic: Diabetes (DR), Hypertension (Hypertensive Retinopathy), Autoimmune (Uveitis, Scleritis), Multiple Sclerosis (ON).
Diagnosis (Gold Standard)
Diagnosis: comprehensive exam. Visual Acuity (Snellen) is baseline. Slit Lamp Biomicroscopy examines anterior segment (cornea, lens) and anterior vitreous. Fundoscopy (direct/indirect) evaluates retina, optic nerve head (ONH), vasculature; crucial for DR, AMD, glaucoma. Tonometry (Goldmann applanation is gold standard) measures IOP. Perimetry (Visual Field Testing) identifies field defects (glaucoma, neuro-ophthalmic). Optical Coherence Tomography (OCT) (gold standard) for macular diseases (e.g., DME, wet AMD) & glaucoma progression. Fluorescein Angiography visualizes retinal circulation (DR, wet AMD). Gonioscopy evaluates anterior chamber (AC) angle (distinguishes glaucoma types).
Management (First Line)
First-line management:
- Refractive Errors: Corrective lenses (glasses, contacts). Surgical: LASIK/PRK.
- Cataracts: Phacoemulsification + IOL implantation.
- Open-Angle Glaucoma: Topical prostaglandins, beta-blockers (IOP lowering). Laser trabeculoplasty (SLT) or trabeculectomy if medical therapy fails.
- Acute Angle-Closure Glaucoma: Medical emergency. Topical IOP-lowering drops, oral acetazolamide. Definitive: Laser peripheral iridotomy (PI).
- Diabetic Retinopathy: Panretinal photocoagulation (PRP) for proliferative DR; anti-VEGF injections for DME & proliferative DR. Strict systemic control.
- Wet AMD: Intravitreal anti-VEGF injections.
- Bacterial Conjunctivitis: Topical broad-spectrum antibiotics.
- Corneal Abrasion/FB: Removal, topical antibiotics, cycloplegics.
- Retinal Detachment: Urgent surgical repair (vitrectomy, scleral buckling).
Exam Red Flags
- Sudden, Painful Vision Loss: Acute A-C glaucoma, ON, keratitis, uveitis.
- Sudden, Painless Vision Loss: CRAO (emergency), CRVO, RD, Vitreous Hemorrhage.
- Severe Eye Pain with Headache/Nausea/Vomiting: Suggests acute A-C glaucoma.
- Fixed, Mid-Dilated Pupil: Acute A-C glaucoma, CN III palsy.
- Proptosis (pain, restricted EOMs, fever): Orbital cellulitis (emergency; vision loss, cavernous sinus thrombosis (CST) risk).
- New Binocular Diplopia: CN palsies, myasthenia, intracranial pathology.
- Chemical Eye Injury: Immediate, copious irrigation.
- Globe Rupture/Penetrating Injury: Peaked pupil, hyphema, reduced VA. Shield eye, STAT referral.
- New Onset Floaters, Flashes, or 'Curtain' Effect: Retinal detachment – urgent referral.
- Relative Afferent Pupillary Defect (RAPD): Unilateral ON/retinal disease (e.g., ON, CRAO, severe RD).
Sample Practice Questions
A 45-year-old contact lens wearer presents with severe left eye pain, photophobia, foreign body sensation, and decreased vision for 24 hours. She admits to sleeping in her extended-wear contact lenses. On examination, there is conjunctival injection and a white infiltrative lesion on the cornea. Fluorescein staining reveals a large, branching, dendritic ulcer. Which of the following is the most likely causative agent?
A 72-year-old female complains of progressive, painless blurring of her central vision and distortion of straight lines (metamorphopsia) in her right eye over the past 3 months. She is able to see objects in her peripheral vision. An Amsler grid test shows wavy and missing areas in the center for the right eye. What is the most likely diagnosis and the specific diagnostic imaging and treatment for the 'wet' form of this condition?
A 60-year-old male presents with a 2-week history of painless, progressive central vision loss in his right eye. He reports metamorphopsia (straight lines appearing wavy) and difficulty reading. On fundus examination, there is drusen and subretinal hemorrhage with associated exudates in the macula of the right eye. The left eye shows only scattered drusen. What is the most appropriate initial treatment for his right eye?
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